Adapting to Change in a Pandemic

Several months into the pandemic, we are all feeling a little weary…tired of the constant worry, tired of endless safety precautions most of all, tired of avoiding social connections for fear of getting sick. Coronavirus precautions are so draining!

Psychologist Carisa Parrish says, “Trying to adhere to anything extra is always a challenge,” says Parrish. “You can add extra steps to your routine for a few days, but sustained behavior change is hard. Especially when no one around you is sick, and you just don’t feel like wearing a mask or saying no to things you like to do. But the fact is, the precautions work.”

Here are a few tips that Parrish suggests in order to make it easier to safely make it through this pandemic:

Make a commitment: Many safety precautions are not convenient, but that doesn’t mean they aren’t worth the inconvenience.  Just like choosing to wear a helmet when riding your bike, make a commitment to keep yourself and those around you safe by washing hands, maintaining physical distance and wearing a mask in public.

Stay Flexible: Research about COVID-19 is constantly evolving and recommendations do change, which can be frustrating and cause confusion. Follow guidance from reputable sources and use your best judgement. It’s worth it to keep up with the changes.

Practice, Practice, Practice: Habits do not evolve overnight.  It takes many weeks and sometime months before a new protocol becomes habit. Stay the course and continue reminding children until they become accustomed to the safety routine.

Keep Supplies Handy:  Ensure you have enough masks in the house so that you can always locate one when you need it. Don’t forget to regularly wash those reusable masks too!  Keep hand sanitizer and wipes in your car or purse so you have them handy whenever needed.

Make it Fun for the Kids: Kids often have their own sense of style.  They will be more likely to comply with safety precautions if they have some say in the process.  For example, allow them to customize their own mask or pick their favorite design online.  By the same token, give them the option to select their favorite scented hand sanitizer with a cool clip they can add to their backpack.  Consistent reminders are also a good idea until these measures become habit.

As you continue to take these safety precautions throughout this pandemic, if you feel drained and stressed, check out these tips to help deal with Pandemic Fatigue.  The most important thing is not to give up.  The coronavirus is not going away soon, however continuing to comply with common safety precautions while doing our best to continue living our lives in the safest manner possible, is our best chance of success.

* If you are in pain, physical therapy can help. At HARTZ PT, we are taking extensive safety precautions in the clinic. We also offer free phone consultations and telehealth appointments for those who don’t yet feel comfortable coming into the clinic.  A pain-free life is worth it.

Source: Hopkins Medicine

Five Tips to Reduce Pandemic Fatigue

Six months after the onset of COVID-19 in the United States and the end is nowhere in sight.  It is not a surprise that many of us are dealing with Pandemic Fatigue.  It’s a very real feeling of exhaustion stemming from the effects of the pandemic on your life — from stay-at-home orders to the fear of getting sick to losing your job. Dealing with intense emotions, such as fear, anxiety, and loneliness day in and day out can wreak havoc on your energy levels.  You may be feeling edgy or nervous, having trouble sleeping or focusing or lack motivation.  Know that you are not alone.  Here are some tips to help you cope.

#1: Take care of yourself: When we are feeling drained by all of this and have so much on our minds, don’t forgot to take care for your physical and mental well-being.  Make sure you are getting enough sleep and maintaining a nutritious diet. Though it may be difficult to drum up the motivation, exercising every day is important too. Doing these things will boost your energy, lift your mood, and strengthen your immune system.

#2: Limit your news intake: It is a good idea to ensure you are up to date on the latest coronavirus information, however too much news can overload you with negative emotions and zap your energy. Take a break from the news for a day or two and see if you feel better.

#3: Lower your stress: Focus on activities that lower your stress levels and bring calm.  Whether that’s practicing meditation, playing with your pets or taking scenic pictures on a nature walk, anything that takes your mind off the pandemic can be helpful.

#4: Create New Traditions: Many of our former traditions have been turned upside down by social distancing and fear of contracting the virus.  Consider creating new traditions, either just with your family unit at your house (ie: Junk It Up Friday Movies Nights, Family Hikes or Game Nights) or with your greater community through virtual happy hours, socially-distanced walks with a neighbor, or online book clubs.  These new traditions will create new ways to connect with others and potentially be something to look forward to.

#5: Learn a New Hobby: Learning new things can be a great mood booster.  With the new wealth of online resources, you likely won’t even have to leave your house.  You can learn to play an instrument, practice a new language, take an online course, or study photography.  As a bonus, you can show off your new skill and impress your friends with what you’ve learned at the next socially distanced get-together!

These tools can provide you with additional tools to make it through this unprecedented time and come out on the other side a stronger happier person.  If persistent pain is adding to your fatigue or lack of motivation, consider scheduling a free phone consultation with a physical therapist.  Physical Therapists are musculoskeletal experts who can find the underlying cause of pain and develop a plan to help you reduce or eliminate that pain. Don’t delay! Call today.

Source: UCLA Health

Simple Tips to Help You Make it Through the Pandemic

Just a little while ago, many of us were living our lives without restrictions.  We joined friends and family for dinner and entertainment.  We were starting to see breaks in the weather which inspired shopping trips for spring clothing or trips to get pedicures.  Children were breaking free of the indoors; the familiar sound of bicycles and laughter was filling our neighborhoods once again.

And then it all just stopped.

Our new mandate requires an end to most of what we used to think was normal behavior…human contact, freedom, independence and perhaps general happiness.  This allows for an increase in less than desirable conditions, such as isolation, depression, anxiety and grief.

Let me be clear in saying, you are allowed to grieve and to appreciate the lives we lived so freely before.  Going forward, we need to take each of those steps to accept the reality of life as it is now, even if it is temporary.  We can use this time as an opportunity to ground ourselves and really focus on what is important…because life will go on. We have the time to do better, be healthier, love more openly and live with gratitude. Consider these helpful tips to combat the mental cobwebs and physical limitations of our space:

Yoga is a connection between mind, body and spirit.  It focuses on meditation and breathing.  It forces your mind to focus on the body’s capabilities which in turn allows for a mindful  meditation.  Meditation is helpful to relieve the symptoms of anxiety and depression, as it allows you to categorize your thoughts.  Almost like a card catalog or a thought rolodex- organization of your mind will help ease anxious overthinking.  Yoga is also a great way for all ages to increase their flexibility, circulation and muscle tone.  Yoga emphasizes on controlled breathing, which has shown to increase immunity and decrease stress on the cardiovascular system.

Walking  Exercise releases endorphins, tiny hormones that make your brain happy.  Besides the pure joy of walking, a 30 minute stroll has been proven to help strengthen your bones and muscles, help reduce stress, improve your balance and coordination and help reduce other cardiovascular ailments.  As we spend more time with Netflix and our couches, a daily walk becomes even more important to keep up our muscle tone and mood!

Sunshine: A daily dose of sunshine and some outdoor air will not only increase your mood but it will also stimulate your body to make Vitamin D.  That’s right, your body uses sunshine to stimulate Vitamin D synthesis from the cholesterol in your skin cells.  Most of us (roughly 42% of Americans) are deficient in Vitamin D as well.  Vitamin D has been proven to fight depression, help aid weight loss and boost immunity.

B Complex Vitamins (with Zinc): These are the powerhouse vitamins.  They are beneficial to general health and stress reduction.  They promote healthy cell function, increase of red blood cells and energy levels.  Zinc has also been proven to aid the immune system.  Most B Complex vitamins have the addition of Vitamin C and Vitamin E, these are increasingly important during cold and flu season because of their antioxidant and immune support.

Technology: Take advantage of virtual resources for interactions with friends and family.  Facetime, Zoom, Skype or even Facebook messenger allow for face to face communications.  As humans, we are a social species.  It is a core human need.  It is so important now to continue to connect with our loved ones even if it is on the other side of a screen.

Eat Healthy!  Drink Water!  Get plenty of sleep! It has probably been said time and time again.  We tell our children, we tell our friends but rarely do we take our own advice.  A healthy, balanced diet, low in processed foods and sugar is the best defense we have to keeping our bodies healthy from the inside out.  Drinking at least 8 8oz glasses of water a day allows for hydration while your body flushes toxins and lubricates the mucus membranes and joints.  A good night’s sleep is vital for your body to continue checks and balances.  Sleep keeps the body’s metabolic functions working correctly, it is important for a healthy heart and brain.  Good sleep is the catalyst for so many self-nurturing habits.  Find the time to relax every night.  Adopt a routine that allows the brain to know it is time to unwind for a restful night’s sleep.

And it is important to remember we will get through this, one day, one hour, one minute at a time.


Ten Ways to Excel as a Teenager during Quarantine

Being a teenager during the COVID-19 pandemic hasn’t been easy.  Schooling has switched to online learning which is a challenge, social events have been cancelled and you can’t even go outside to play pick up with your friends.  The pandemic has changed our way of living, how we interact with our friends and forced us to stay home and spend more time with our families.  This may or may not be a good thing in the mind of a teenager.  However, it is important to find ways to get motivated and active again! Being a teenager presents many challenges, but with some encouragement, character, and grit, we can all make it through this pandemic.

Here are 10 tips to help you get through this unprecedented time.

  1. Get into a Routine. Since your standard school schedule is gone, let’s focus on getting back to the basics. Try to set an alarm to wake yourself up in the morning…maybe it’s not 6am as was typical to catch the bus, but something before noon is encouraged. Take a shower and make sure that you’re not wearing the same clothing every day. Eat breakfast, do some basic stretches to get the body loosened up, and go over a mental checklist of tasks/goals for the day/week. Communicate with your parents about what their expectations are for the day.
  2. Stay Active. Consider reaching out to your coach for workout ideas or preseason expectations. Go back to focusing on the basics for the sports you play and nail down your skills. (Juggling the soccer ball, setting the volleyball, nailing those 3-point shots for basketball, etc.) If you’re not a sports fan, there are a lot of great home workout ideas that you can complete at home without any equipment. Here is a link to a few exercise ideas.
  3. Set a Limit on Social Media/Phone time. We’ve all done it…had those moments where we glance at the clock and realize that we have been lost on social media for way too long.  While social media can be a great avenue for being able to connect with people, it can be a huge time waster and motivation discourager. Set a realistic limit for phone/TV/social media time each day and then if you stick to it, plan out a small reward for the end of the week.  You may be shocked by how much more you are able to accomplish.
  4. Help Out Around the House. Now that you are home the majority, if not all of the day, it can be easy to slack off and go through an entire day without feeling like you accomplished anything. I would challenge you to make a list of chores that need to be completed and then check them off one by one. Maybe it’s taking out the trash, organizing the pantry, or entertaining your younger siblings. All of these activities can help provide you with purpose for the day and aid in reducing stress levels around the house.
  5. Be Intentional About Schoolwork. This transition to online schooling may seem overwhelming and unconventional. Yet at the same time, look at this as an opportunity for you to better prepare yourself for the rest of your high school education or for college. Make daily challenges for yourself to increase your motivation levels. Ex: Complete my math assignment in under 45 minutes or read 30 pages of my book before lunchtime. Remember to take breaks to stretch and get up to move around after sitting for extended periods of time. Here is a link to some simple stretches to complete during breaks from schoolwork
  6. Check in on Your Friends and Family. This is a challenging time for many as we are isolated in our homes and are not able to see our friends and family on a regular basis. Make it a goal to check in “virtually” with one family member, neighbor, or friend a day. Let’s all work together to improve the mental status of the people we love and care about. A little intentionality can go a long way.
  7. Research Potential Job Opportunities or College Options. Having more free time makes for a great opportunity to fill out applications for college and learn more about different career pathways that you may consider for the future. When the restrictions from COVID-19 are gone, consider organizing a time to job shadow at a potential career field that piques your interest.
  8. Drink More Water . When our schedules change, it can be easy to forget about the standard activities that we would normally complete on a daily basis. Such as drinking LOTS of water in order to keep us hydrated. Try to aim for drinking at least ½ gallon of water per day. Find your favorite water bottle and then do the math in order to determine how many time you need to refill it in order to reach your goal.
  9. Get Creative in the Kitchen. Learning simple cooking skills can be essential for helping you gain independence and confidence which will come in handy when you transition into college living or start renting your own apartment. The pressure and busy lifestyle of society can make it very tempting to order out often but being able to cook simple meals can aid in a healthy lifestyle and healthier budget. During quarantine is a perfect time to be able to learn cooking skills from your parents as you are in a setting where you can make mistakes and ask questions. Start with something simple: master scrambled eggs, pancakes, and bacon or learn how to cook your favorite meal.
  10. Learn a New Hobby. Whether it’s baking, calligraphy, wood working, magic tricks or picking up a new musical instrument, the sky’s the limit. See this season of “more free time” as an opportunity to try something new.

Healthy Eating during Uncertain Times

As the days go by and we are spending extended time at home, many of us are wondering how to keep our bodies healthy. Maintaining proper nutrition and good eating habits can be extremely beneficial during times of uncertainty. Don’t let stress or boredom wreak havoc on your diet. It’s important to be mindful of what you are consuming to avoid binge or impulse eating.

PLANNING: Remember when there seemed to never be enough time to cook? Well, that’s no longer an issue! A great way to keep your nutrition on track is to start with a plan. What are you going to eat for breakfast, lunch and dinner? Everyone in your family probably has an opinion as to what they would like to eat. Involve the family in sharing ideas so that everyone has a voice in planning meals for the week. Perhaps you have some family favorites or you clipped a recipe from a magazine that you never got around to trying? If you need some inspiration, Pinterest is a great resource.

SHOPPING: Once the menu is planned for the week, it’s time to make a grocery list. Carefully list all items that you don’t have on hand. Sending one family member to the grocery store once a week for needed food is recommended at this time. Hang the weekly family menu on the refrigerator. When it’s time to cook, assign various tasks to each family member. Use it as a teaching moment with your kids, show them how to follow a recipe, how to measure, etc. Cooking is a life lesson everyone can learn and improve upon!

Need some help getting started? Below are a few tried and true recipes you may enjoy:

  • Frittatas are a great way to use leftovers in your fridge. The main ingredient is eggs. The rest of the ingredients are totally up to you, go ahead and toss in leftover veggies, beans, grains or even chopped meat. Feel free to experiment with what you have on hand. Here is a basic recipe, Vegetable Frittata.
  • Soups are the ultimate comfort food. Make a double batch so you have extra for future quick meals. Lemon Chicken Orzo Soup comes together quickly and is something the whole family will enjoy.
  • Snacks! Everyone loves to snack…it’s an added bonus if it’s healthy. Making protein energy balls is a fun activity the whole family can do together. Gather your ingredients and a few bowls and get those creative juices flowing. Energy Balls {The Ultimate Guide with 7 Recipes}

Preparing healthy meals for now and prepping meals for future use are great ways to stay busy and do something good for yourself. Remember, relax and have fun in the kitchen If your family occasionally eats freshly baked chocolate chip cookies for lunch, no worries, sometimes we all need to treat ourselves!

The Importance of Standing throughout the Day

As the days of being under quarantine lengthen, the phrase “I have nothing to do”, is becoming more and more common. In some cases, this is creating a lot of “couch-time” and not a lot of movement throughout the day. One of the easiest things to add into your daily regimen is to make a goal to stand up at least once an hour.

There are so many health benefits to standing every hour, one of them being boosting your mood and energy levels. At first, the quarantined sounded kind of nice…stay home to read a book, watch Netflix and take mid-day naps…however after 3-4 weeks (or longer) it may become lonely, and rather depressing. Being told to not do what you like to do and being away you’re your friends and family who don’t live with you, can make for a long day. Any little thing to help boost your mood and your attitude is worth it, and if standing is one way to help, then make it happen!

Standing once an hour also burns more calories than sitting. Again, with this extra time at home, an easy way to pass the time is to eat. Eating and sitting more is not a great combination for maintaining a healthy weight. While you are up, why not take a stroll through your house? Walk up and down the steps to get the heart rate up a little. The song that has been on repeat for me lately has been Supertramp’s “Take the Long Way Home”, a good reminder to take the long way to go places (bathroom, bedroom, mailbox, etc). Burning calories more frequently will help keep the weight down, which in return will make your joints less inflamed and more comfortable.

Another plus to standing every hour is it helps improve heart health. Sitting can cause increased blood sugar levels and increased blood pressure, so again, making it a point to stand up throughout the day can help keep these numbers intact, allowing for your heart to be happy and healthy.

Couches and recliner chairs may be comfortable in the moment, but in the long run, they can take a toll on your spine. This creates poor positioning and a lack of support for your neck and low back, causing tight muscles and painful joints. Making it a point to get up, move around, and change positions will help stabilize these muscles and prevent your spine from being in a bad position for too long.

I know it is easy to get caught up watching tv all day on the couch (I have done it as well!), but set a goal for yourself to stand at least 2 minutes every hour, and I can guarantee you will feel more comfortable and productive throughout your day!

The Benefits of Fresh Air on Mental Well-being

With the end of winter and the beginning of spring, many people are anxious to get outside. However, the recent spread of novel COVID-19 have required many to self-isolate, thereby increasing the amount of time that people are spending indoors. While many are feeling anxious, bored and stressed with the requirement to stay home, it is important to acknowledge the benefits of fresh air during this unprecedented time.

Spending 20 minutes outside each day, preferably in a green space, can reduce blood pressure, heart rate, stress and prevent development of psychiatric disorders.

A study published in the International Journal of Environmental Health Research found that simple being in a green space seemed to be enough to spark a change.  94 adults were given a fitness tracker and instructed to spend time in an urban park doing whatever they pleased.  In addition, each participant answered questions about their mood and life satisfaction to measure well-being both before and after the park visit.  On average, researchers found that well-being increased in 60% for participants who spent time in the park.

If you can’t get outside, another way to increase fresh air is to simply open the windows in your home. Even when the outside temperature is cooler, opening the windows in your home can achieve many benefits:

  1. Decreases water vapor in the air produced by humans and pets
  2. Increases oxygen
  3. Improves mental focus
  4. Allows for venting of airborne chemicals and odors

These small changes can improve quality of sleep, immune function, as well as the overall air quality within the home.

The importance of social distancing during a pandemic is of utmost importance; however, among other habits and precautions, the improvement of mental well-being in your daily routine should be a priority. Incorporating exposure to fresh air can be an incredible benefit to your physical health but also to the environment in which you spend much of your time.


Ducharme, Jamie. “Here’s What Being Outside Can Do for Your Health.” Time, Time, 28 Feb. 2019,


Heat or Ice for Pain? It Depends…

When it comes to managing symptoms at home, many patients report they avoid utilizing adjuncts, including heat and ice, due to a lack of knowledge on which one they could, or should, be using. It is important to have more tools in our back-pocket for managing pain levels (and other symptoms such as swelling & bruising) especially for patients who are not able to make it into the office for an appointment. Both heat and ice work in different way to change the way our nerves sense pain and the way our brain processes the pain sensation. The goal of this post is to help you understand under what circumstances each is indicated.

Ice acts as a vasoconstrictor (ie: it makes the blood vessels smaller) to allow for less blood/fluid to pass into the surrounding tissues. This is especially important following a recent, acute injury, including (but not limited to) sprains, post-operatively or a gout flare up because these traumas initiate their own inflammatory process.  While some inflammation is necessary to the overall healing process, promoting extra inflammation through the use of heat during this time is not recommended. Ice is particularly important in the first 24-48 hours following a new injury, and while there are varying definitions of acute and chronic based on the type of injury, utilizing ice to decrease inflammation can often be a benefit to healing up until the six week mark.

Here are some additional tips to consider when applying ice:

  • Total time of use in one sitting should not exceed 15-20 minutes, as frostbite could occur.
  • Ice packs should never be placed directly on the skin. Instead try wrapping the ice pack in a thin towel.
  • Allow 2-3 hours in between sessions and then ice again.
  • For maximum inflammation reduction, it is recommended you elevate the affected area above your heart; keeping the area below the level of your heart, such as in a recliner, is not a sufficient elevation height to remove this excess fluid from an extremity.

Ice should be avoided if you have been previously diagnosed with: Raynaud’s disease, allergies to cold temperatures, impaired circulation (including peripheral vascular disease or blood clots), and on open wounds. It is important to be cautious with your use of ice if you have a history of hypertension, sensory deficits, such as from neuropathy, or Rheumatoid conditions.

Heat, on the other hand, acts as a vasodilator (ie: the circumference of the blood vessels expands) to promote an increase in blood flow to the tissues. Heat can be an important tool when dealing with chronic pain, muscle tightness, and arthritis. Heat helps to promote relaxation, relieve stiffness and reduce muscle spasm. As a result, you’ll often find increased motion at the impacted joint and improved pain levels.  If you find that your joints/muscles feel better after a nice warm shower/bath, heat is probably for you. If you are beyond the six week mark of an acute injury, you are also likely ready to try heat (if you prefer heat to ice).

There are many different heating methods for use at home, most commonly including moist heat and heating pads. Here are some tips for proper use of heat:

  • Heat should be applied for bouts of 15-20 mins as this gives the underlying tissues time to heat to their optimal temperature to have some of the effects previously mentioned.
  • There is no hard and fast rule of how many times per day you can heat, however it is important to monitor the skin for signs of burns (including redness, blistering) or to have someone in your home who can help monitor this if you do not feel you are sufficiently able to on your own.
  • It is important NOT to fall asleep while utilizing a heating pad, as this can lead to burns and presents a fire hazard.
  • Moist heat packs should be wrapped in 6-8 layers of towels to prevent possible burns; laying directly on a moist heat pack should also be monitored as this can speed the heat transfer process and lead to faster negative skin changes.

Heat should not be used in these instances: over an area of malignancy, presence of acute musculoskeletal trauma, arterial disease, bleeding or hemorrhage, over an area of compromised circulation, in presence of peripheral vascular disease or thrombophlebitis, areas where you have recently applied a heat rub/cream.

If you are at home without access to a traditional hotpack, here are some other ideas:

  • Fill half an old sock or ziploc bag with uncooked rice, tie or sew shut & microwave for 1-2 mins (start with less time and go up if needed, don’t put ziploc bag directly on skin)
  • Soak a kitchen towel in hot water and put in ziploc bag (or put wet towel in ziplock bag. (Do not seal bag when microwaving) Heat for 1-2 minutes.
    *Be sure to test heat prior to applying. If too hot, use a kitchen towel or paper towels as a barrier until it cools down.

Should you have further questions on managing your symptoms independently, please do not hesitate to reach out to the staff at HARTZ PT.

Physical Therapy Can Help With Your Resolutions

As one year comes to a close and another begins, people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into “better shape” are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking and being merry can lead to pain, injury and disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement and can help you safely reach your fitness goals. People think of PTs as the person to see after an injury, but a visit before you change your activity level could prevent injury in the first place. The most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your evaluation which will include an assessment of your strength, range of motion, and functional movement patterns – think jumping, running, squatting, carrying. They can then prescribe exercises or movements to address the issues found and get you safely moving into the new year!

So stop only thinking of physical therapy of something you need only after you’re injured and plan ahead!  In this case, it’s true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist before you start on your resolution can keep you on track, injury free, and help you reach your goals for the new year!

PS: If you are looking for a unique monthly membership program which provides members with an individualized exercise program that is monitored and progressed by an Exercise Physiologist, consider our Medically Adapted Gym, available at Lancaster-West office and Mount Joy office in January 2020!   All new clients receive a comprehensive evaluation by the physical therapist to identify weaknesses and risk areas (billed to insurance).

Recovery after a Concussion…A True Story

In the fall of 2016, our son sustained a concussion on the football field as the result of a direct hit. While he had been well-coached in how to hit and block properly to avoid injury, there was little that could be done to avoid sustaining a bad hit.

Thankfully, he never lost consciousness, but immediately experienced significant headache, dizziness and extreme sensitivity to light. He was checked out by the on-site EMT and was recommended to see a doctor the following Monday. Over the weekend, his symptoms increased significantly, to the point where he was wearing sunglasses indoors and experience general confusion. Riding in a car was painful, as was listening to music and any type of reading or viewing on a screen.

Our family doctor recommended the standard concussion protocol at that time: no school, no sports or physical activity, no reading, and no screens until he was symptom-free. He was 14 at the time and might as well have been told not to breathe, but we committed to following the protocol in hopes of his quick recovery.  Within a few days of this recommendation, he became restless, frustrated and discouraged. His football season was over, basketball was uncertain, he would miss a total of 18 days of school, and worst of all, symptoms were not changing and he had no outlet for his angst.

At that point, we pursued additional input at Hartz Physical Therapy and were introduced to Drew Nesbitt. The first thing that impressed us was Drew’s ability to interact with a teenager. He treated our son with respect, communicating directly with him and not through us, and he knew the culture of local sports and was easily able to talk recent scores, player highlights and top teams. He instantly put our son at ease.

Up to that time, we felt that we basically had to wait in a dark tunnel for symptoms to disappear until there could be any return to normalcy, and it was maddening to feel so helpless in the recovery process. We quickly learned that Drew was highly educated and well-researched in the concussion arena, and several studies were just beginning to reflect that some physical activity might increase the pace of recovery and strengthen brain function. He developed a multi-faceted plan that allowed our son to re-introduce activity (cognitive, vestibular, physical) that slowly re-strengthened what had been damaged. More importantly, the opportunity to DO something to work toward recovery created motivation and hope!

While Drew initiated the plan, many on the team at Hartz walked it out with our son and their commitment to his success was evident. We were truly impressed with their research and constant willingness to push our son to, but not beyond, his limit. As they worked with him, they were educating him about the injury itself, what each exercise or activity was aimed to strengthen and how he could protect himself from re-injury. In all of this, they maintained realistic goals with a hopeful perspective. It was an experience that created a deeper level of maturity and personal responsibility in our son for his own health and well-being.

We are truly grateful for Drew and the entire team at Hartz PT. Looking back, our one regret is that we didn’t go directly to their office the morning after the injury. We believe our son’s overall recovery would have been shorter with the application of current research and strategy.

~ Testimonial written by Kelly M. whose son was seen by Drew Nesbitt, DPT

Heat Stroke: It can Happen to Anyone…A Personal Reflection

Every summer throughout my entire life I have heard the repetitive warnings that as the heat and humidity increases, there are dangers of heat exhaustion and heat stroke. With those warnings, I tended to shrug them off with the ignorant mindset of “that isn’t going to happen to me.” I wasn’t totally belligerent…I prepared myself as best I could with proper hydration prior to activity and avoiding direct sunlight during activity; however it was not unheard of for me to go out for a 20 mile run in >90 degree weather with no supply of water with me. I had gotten away with that mindset for years including multiple marathons/ultramarathon and a bike ride across the country which included crossing the Badlands in 120+ degree weather. However, in the summer of 2018  the effects of the heat got the best of me in a scary way.

Hindsight is 20/20 and thinking back on how this day went, I feel foolish sharing the mistakes I made, but understand I’m lucky the situation did not end worse and feel that this is a learning opportunity. To set the stage, myself and a friend that were both training for fall races decided to attempt to run around Blue Marsh Lake  in the afternoon on a 95-degree day. We both knew it was going to be hot, however with work schedules and other engagements, beginning at 1 PM was the only time we could run together. Rushing to the starting location directly after working in the morning I scarfed down a PB&J and drank a 20 oz bottle of water. We drove straight to the trail and each had 16 ounces of water with us. The heat that day was oppressive and there was a constant flow of sweat coming off of our bodies. Being the middle of the day, the sun was piercing through the tree canopy and we were running with a real feel topping 100 degrees. We both sipped our water, but only slowly in an attempt for it to last the entirety of the run. We both felt ok for the first 13 miles, however on the return trip my legs slowly began tightening, my vision got darker and body began to feel a cool sensation. Understanding this as the early signs of dehydration, I quickly consumed the rest of my water. Unfortunately, it was too late. Those initial symptoms began to worsen to the point I wisely began walking and taking breaks cooling off my body in small brooks; running was not an option anymore. It took over an hour to complete the last 3 miles with no water for re-hydration and the sun continuing to beat down on us as we walked back to the car.

When we arrived to the car, my vision had continued to darken, muscle cramps increased and speech began to slur. My friend helped me into the car and quickly began to drive me to Sheetz for replenishment and air conditioning. As we drove, every muscle in my legs began to cramp/tense, my vision was almost entirely blank and I began to lose voluntary control of my hands. We arrived at Sheetz and my friend got 2 Sheetz employees to aide him in carrying me inside as I was unable to do so myself. Laying on the floor at the entrance of Sheetz my friend got bags of ice and placed them all over my body. It felt like an eternity, while customers coming into the store stared at me while I lay unable to move, it was actually about 20 minutes.  As my body began to cool off, control of extremities began to return.  I slowly regained full control of my body. During that period a concerned patron of Sheetz had called 911 and an ambulance arrived. The EMT checked me out and cleared me.  The next few hours were kind of a daze with a dull headache, a fever and sporadic cramping of my legs and arms. After replenishing with solid nutrients and liquids and a good night sleep, I felt much better the following day.

I fortunately made it through this episode with no lasting impairments, but was humbled and learned a few lessons in the process:

  • A heat stroke can happen to anyone
  • To avoid heat related illness do not participate in activity on excessively hot days with high humidity
  • Avoid prolonged exposure to the sun on days > 85 degrees
  • Replenish with fluids at 8 oz an hour
  • Be aware of signs related to heat illness: Headache, Dizziness, Nausea/Vomiting, Muscle Cramping
  • If any of these symptoms are present rest, replenish with fluids and seek medical attention if they persist.

For more information about Heat Stroke, please check out this post


Physical Therapy 1st Option to Treat Low Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.  Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication: Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging: Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not. In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge.  Just getting an image increases the chances that you’ll have surgery by 34%

Surgery: The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are not good! A worker’s comp study looked at a group of 1450 people with similar symptoms: half had spinal fusions and half didn’t. The surgical group had:

  • 1 in 4 chance of a repeat surgery
  • 1 in 3 chance of a major complication
  • 1 in 3 chance of never returning to work again

Physical Therapy: Current clinical practice guidelines support manual therapy and exercise. Research proves that early PT leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids. A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.  Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. With direct access, patients can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

The No. 1 Thing You Can Do to Improve Your Physical Therapy Experience

Dealing with the pain and limited mobility associated with an injury or illness can be stressful for so many reasons. You might have questions like, “How long will I be sidelined?” and “What do I need to do to get better?” Or maybe you’re worried about how you’ll pick your children up from school, walk to the train for your commute or prepare meals for your family.

These are all perfectly normal concerns. Luckily, there are some ways that you can gain control over the situation and ensure that you return to the activities you care most about—especially if physical therapy is part of your plan.

What you can do before your very first appointment—and during physical therapy—to take control of that injury-related stress? First and foremost, it’s important to come prepared for physical therapy. And no, I’m not talking about dressing appropriately and arriving on time (or even better, 15 minutes ahead of your scheduled appointment). That stuff is important, of course, but there’s one thing you can do in the days leading up to your appointment that will set you up for success.

Any guesses? I’m talking about starting a list. What kind of list? Well, every time that you feel pain in the affected area or notice an activity that is harder than it was pre-injury, add it to the list! And the more specific you are, the better. Here’s an example to help drive this point home: Let’s say that you’re recovering from a moderate meniscus tear and you have an appointment with your physical therapist in three days. Take notes on how your knee feels first thing in the morning after you’ve been off your feet. How does your knee react when you stand up from a chair—does it feel unstable? Or do you find that you need to clutch the back of the couch on your way to the bathroom? Sharing each of these details helps your physical therapist understand your limitations beyond the injury printed on your intake form.

Now let’s take that list a step farther and add some details about the activities that you typically participate in on a regular basis. Let’s say that you normally play a weekly round of golf, spend your mornings weeding your garden or meet up with friends for a four-mile walk two evenings a week. These activities have become an important part of your life so let’s make sure that they’re factored into your list, perhaps in the “what you hope to get out of physical therapy” category. Painting a clear picture of how active you are—and what types of activities and sports you participate in—can help your physical therapist design an individualized treatment plan and to better help you on your road to recovery.

Top Ten Tips to Avoid Injury while Spring Cleaning

Spring cleaning is a great way to recharge and get your house back in order, however organizing closets and cleaning out the basement can create achy, stiff joints, and tight muscles. Here are 10 tips to help you avoid injury while cleaning this spring:

  1. PACE YOURSELF: It can be a long, and physically demanding task to clean out the house, so space it out and do not try to do it all in one day. A common reason that patients come in to see us at HARTZ is because they over-do it with housework. For example going up and down the stairs all day, cleaning for 6+ hours straight, reaching overhead wiping shelves for an extended period, etc.
  2. HAVE A GAME PLAN: For example, if you are going to clean out the basement, avoid unnecessary trips up and down the steps by being prepared. Have the trash bags and cleaning supplies handy, make piles of what to keep and to donate, and then start making the trek back upstairs. Work smarter not harder, your body will thank you!
  3. PROPER FOOTWEAR: While cleaning you will want to avoid wearing sandals, flip flops or slippers because of the poor traction each has. You want to wear athletic shoes or shoes that have a rubbery sole to avoid slips and falls!
  4. PROPER BODY MECHANICS: If you are planning to move heavy objects, be sure to use proper lifting mechanics: bend at your knees, feet shoulder width apart, item close to body and keep a flat strong back (squatting motion). Avoid repetitive movements, use cushions to kneel on, keep your shoulders relaxed when working overhead and avoid tensing your shoulders up to your ears.
  5. START SLOW AND WARM-UP: This may sound a little silly to warm-up before cleaning, but you will be bending and testing your muscles trying to reach every nook and cranny in your home. Doing some light stretching will help you avoid any muscle strains that may come with cleaning.
  6. UTILIZE PROPER TOOLS: Instead of getting on your hands and knees to clean your kitchen floor, use a mop with a long handle. Vacuum cleaners can be heavy and can cause people to have back pain from pushing and pulling them. If you have a history of back pain, try using a cordless vacuum cleaner as they are usually much lighter and easier to move around. When cleaning at a high height, whether it be a ceiling fan, or a high window, be sure to use a proper step ladder to reach those spots.
  7. TAKE BREAKS AND STAY HYDRATED: Cleaning is not a race! If you are someone who cleans every day, you can overuse certain muscles which in turn can cause injury to that muscle. To avoid these types of injuries, it is important to take short frequent breaks. While taking these breaks be sure to drink plenty of water to keep yourself hydrated while cleaning. Keeping your muscles well hydrated is very important to avoiding injuries.
  8. BREAK UP A BIG JOB INTO SMALLER ONES: If you are attempting a big cleaning job, especially alone, it is important to tackle that job with a plan. Break the one big job down into more manageable smaller jobs and complete those one at a time.
  9. LISTEN TO YOUR BODY: If you are having pain while cleaning, then stop and take a break. I know we are inclined to want to finish the job, but fighting through the pain could turn a small problem into a larger one. Cleaning can be a strenuous activity on your body and your body will tell you exactly how it feels. If it is telling you to stop, listen!
  10. PAMPER YOURSELF: After you are done cleaning for the day, take time to assess how you are feeling and pamper those muscles that are a bit sore: utilize a heating pad or ice pack to a trouble area and perform some gentle stretches. Here are recommendations to stretch three areas that commonly take a beating from cleaning:
    1. LOW BACK: may be hurting especially with heavy lifting or even just sitting on the floor for extended periods of time. Lay on your bed and perform some easy trunk rotations, pull your knee in towards your chest, and then trial some hamstring stretches.
    2. NECK/SHOULDERS: may be sore especially if you are hunched over sorting through old files or paperwork. Gentle upper trap and pec stretches will help to relieve neck tension and improve a rounded shoulder posture.
    3. FOREARMS/WRISTS: always work hard when cleaning. To help, perform wrist stretches by holding arm straight out and pulling fingers up (flexor stretch) and then down (extensor stretch). Hold 30 seconds each.

By following these ten simple tips you will help prevent any injuries that may come with spring cleaning. If you ever find yourself in pain that just won’t go away, consider having a physical therapist look at the problem area and give you some tips for reducing pain!  Call us at HARTZ PT anytime!  Happy Cleaning!

~ Alicia Leeking, PTA and Melissa Potts, PTA Student

Chair Yoga for Balance and Overall Well-Being


We all know it’s true…cultivating a healthy lifestyle is a choice that we make on a daily basis.  But what if our bodies are making it more and more challenging to make that choice?  With age, our ability to participate in regular standing exercises can decline and  sometimes, just staying on our feet can be challenging enough!  This decline happens for many different reasons including pain from osteoarthritis or balance deficiencies.

However, the good news is, there are other options for those who have difficulty standing or balancing for prolonged periods of time.

Chair Yoga is one of those options.

Yoga is an excellent way for older adults to loosen and stretch painful muscles, reduce stress, and improve circulation. It also reduces anxiety, helps lower blood pressure, protects joints, and builds strength and balance.  Utilizing various modifications to traditional yoga poses and balancing exercises, chair yoga can achieve many of the same health benefits, while significantly reducing the stress on muscles and joints.  The chair provides support for traditional standing poses, which are modified to be performed while sitting in the chair.

A recent study on Chair Yoga conducted at Florida Atlantic University showed pain reduction, improved mobility and improvement of security and well-being.  This 8 – week program was the first to show Chair Yoga as an alternative treatment for lower extremity osteoarthritis.  In fact, the Arthritis Foundation recommends yoga to improve joint pain, improve flexibility, balance and reduce stress and muscle tension.

If you are someone who has osteoarthritis, trouble with standing exercise or are just looking for a new low impact alternative to regular exercise, you may want to consider adding a Chair Yoga program into your weekly routine.  Yoga adds not only a low impact physical component to your routine, but also a mental one by calming and relaxing participants.  Inevitably this can lead to a greater feeling of happiness and well-being…from which everyone can benefit!

If you’d like more information about Chair Yoga, please contact HARTZ Physical Therapy at 717-735-8880.  We are introducing a Chair Yoga class which will be held at 90 Good Drive, Suite 201 on Tuesdays from 12pm-1pm. The class will be led by certified yoga instructor and current PT Assistant at Lancaster-West, Michelle Newman!  We invite you to join us!  In the meantime, try some chair yoga stretches at home.  Be sure to avoid stretching beyond your comfort level.  Keep it gentle and breathe!

The ABCs of Medicare

If you are approaching the magic Medicare number of 65 years of age, chances are you have been thinking about how you will go about getting on Medicare and what your options are to get the coverage that’s best for you.  This blog is meant to be an introduction to the general options available to give you a starting point for your research.

TRADITIONAL MEDICARE: This in the most well-known coverage and it includes two parts:

  • Part A: coverage for hospital visits
  • Part B: coverage for doctor visits and therapy

MEDICARE ADVANTAGE PLAN: Sometimes called “Part C”, Medicare Advantage Plans wrap Part A and Part B benefits into a private plan administered through Medicare-approved insurance company.  This provides an alternative way to receive your coverage through private insurance companies approved by Medicare.  Most of these plans include additional benefits, such as vision, dental, and/or prescription drug coverage. When you enroll in a Medicare Advantage plan, you are still in the Medicare program, and you are still required to pay your monthly Medicare Part B premium; however, your Medicare services are covered and administered through a single policy.  Since Medicare Advantage plans are available from private companies that contract with Medicare, each plan sets its own premium; some have very low premiums, however, they might not be the right plans for everyone.  The costs and additional benefits vary widely among plans so it is essential to do your research to figure out which one is right for you.

MEDICARE SUPPLEMENT PLAN / MEDIGAP PLANS: Medicare Supplement plans are also offered by private insurance companies and act as just that, supplementing the coverage from Medicare.  In other words, they often pay the costs that Medicare does not. These are also known as Medigap plans. There are many different supplement plans to choose from, varying in cost and coverage. While Medicare Supplement plans may help with deductibles and other expenses not paid by Medicare, they do not cover services if traditional Medicare does not cover them, such as long-term care, dental care, or eye glasses. In addition, these plans do not provide prescription drug coverage.

THESE PLANS DO NOT WORK TOGETHER: Medicare Advantage plans do not work with Medicare Supplement plans. This means that you cannot use your Medigap plan if you enroll in a Medicare Advantage plan. You may enroll in a traditional Medicare plan with a supplement, OR in a Medicare Advantage (known as a replacement plan) BUT NOT BOTH.

MEDICARE PRESCRIPTION DRUG PLAN: If you are looking for a Medicare Advantage Prescription Drug plan, it is a good idea to check whether it covers your prescriptions. Each Medicare Advantage Prescription Drug plan has its own formulary (list of covered prescription drugs). The formulary may change at any time; you will receive notice from your plan when necessary.

CHOOSING THE RIGHT PLAN: When deciding on a plan, it’s essential to compare the benefits and costs in relation to your specific health care needs. The website suggests considering these 7 things when choosing what coverage is best for you:

  • Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
  • Coverage: How well does the plan cover the services you need?
  • Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
  • Prescription drugs: What will your prescription drugs cost under each plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions?
  • Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
  • Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?
  • Travel: If you travel out of state or out of the country, is there any coverage available with any of the plans?

COVERAGE CHANGES / ELECTION PERIODS: Changes to your Medicare insurance can be made during the Annual Election Period, which runs from October 15 to December 7 each year. You can switch from Original Medicare to a Medicare Advantage plan at this time, and make other coverage changes. If you’re already enrolled in a Medicare Advantage plan and want to switch plans, in most cases a good time to do so is during the Annual Election Period.  When you change Medicare plans during the Annual Election Period, your new coverage generally begins on January 1 of the following year. If you’re enrolled in a Medicare Advantage plan and want to switch back to Original Medicare, Part A and Part B, you can do so during the annual election period or during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year.

This is a lot to think about and there are a lot of decisions to make – be sure to do your research to ensure that you are selecting the coverage that is right for you.  There are resources available online and many private insurance companies may be able to offer advice. If you have questions on what the physical therapy benefits are with your plan, please give us a call and we will be happy to get that information for you.

For more information about the Medicare Enrollment Process, click the links below:
Getting Started with Medicare
Medicare vs Medicare Advantage Plans: How to Choose

What is Causing your Elbow Pain?

A common form of elbow pain occurs when the muscles on the inside of the elbow (Medial Epicondylitis) or outside of the elbow (Lateral Epicondylitis) become inflamed and irritated.  You may have heard of “Tennis Elbow” or “Golfer’s Elbow”, as these names typically describe elbow pain based on its location.  However, despite the names, these symptoms can be brought on by a variety of different motions or activities that involve the elbow.  Both forms of elbow pain are typically caused by overuse from a repetitive activity.

Tennis Elbow (Lateral Epicondylitis) occurs when the extensor muscles of the forearm become inflamed.  Many of the muscles on the outside of the forearm attach to the outside of the elbow on the humerus bone at a spot called the “lateral epicondyle”. Symptoms may include sharp pain, swelling, and tenderness when the spot is touched or bumped.  In addition, repetitive motions of wrist extension, which is used when performing a backhand tennis shot, can aggravate symptoms.

Golfer’s Elbow (Medial Epicondylitis), on the other hand, occurs when the flexor muscles on the inside of the forearm become irritated.  Just like in Tennis Elbow, the flexor muscles on the inside of the forearm attach to a common bony spot on the humerus called the medial epicondyle and may become irritated and painful after overuse or repetitive motion.  A common motion is the gripping of a golf club, hence the name “Golfer’s Elbow”.

So, what can you do if you have this pain? The best approach is to rest and ice the affected muscles.  Since these symptoms are caused by overuse, taking a break from the aggravating activity is important.  Along with resting, decreasing the inflammation in the elbow is very important. Icing the elbow for 10-15 minutes every 3-4 hours can be an effective way to help decrease pain levels.  In addition, some gentle stretching may help to alleviate tightness in the muscles.  Finally, as symptoms decrease, strengthening exercises are important to help prepare the muscles for returning to the stressful activities.  In addition to these treatment plans, people may find relief from wearing a brace just below the elbow to help reduce the amount of strain placed on the affected tendons.





In more severe cases, NSAIDS may be needed to help reduce pain and inflammation in the elbow.   As the symptoms decrease, it is important to begin a stretching and strengthening program to help restore full strength and range of motion in the affected elbow.  A gradual return to activities is encouraged, however any increase in pain or soreness could indicate that the elbow is not ready to return to full activity levels.

If you have are having difficulty treating the pain and soreness in your elbow on your own, physical therapy can be very helpful in guiding you with appropriate stretches and strengthening exercises for either Tennis Elbow or Golfer’s Elbow.   In addition, PT can assist you in returning to the activities you love, including golf or tennis.

Benefits of High Intensity Interval Training (HIIT)

It seems like with every new year, comes new fitness trends and work out programs. Over the past few years, High Intensity Interval Training OR HIIT has been at the forefront of fitness magazines and news headlines and is becoming an increasingly popular topic at universities and research facilities across the world. So, what exactly is HIIT and what is so unique about this approach to training?

While there is no universal definition, HIIT is characterized by working at high intensities (usually, > 80% of your max heart rate) for moderate amounts of time with short intervals of rest in between. Due to the “all out” nature of these workouts, HIIT workouts typically last around 30 minutes. What is so unique about these intense, focused workouts, is the increased cardiovascular and muscular conditioning benefits that can be gained in the same amount of time verses traditional workouts.

 Research has shown tremendous benefits by replacing 1 hour of steady state cardio per week with two 30-minute sessions of HIIT in healthy adults who exercise consistently.

In a study completed at Penn State University, Dr. Jinger Gottschall researched the effects of HIIT training on already active adults.  Over a 6-week period, she found that participants who replaced 1 hour of steady state cardio with two sessions of 30 minute HIIT achieved the following gains:

  • Improvement of their VO2 max (maximum oxygen consumption rate) by 6.4%
  • On average, a 14.5% decrease in triglycerides
  • On average, a 2.1% decrease in body fat
  • On average, a 15.7% increase in leg strength

For the endurance athletes competing at higher level competitions, research has shown similar results in improving overall endurance, most notably in long distance runners.

So, what does all of this really mean? For the already active adult who may find themselves in a fitness “rut”, replacing 1 hour of steady state cardio with two 30-minute sessions of HIIT training may offer diversity and efficiency to your workout regimen, especially for those with limited time.

 IT’S NOT FOR EVERYONE: While the benefits of incorporating HIIT training into your daily workout routine are enticing, there are a few things to consider before starting. Due to the “all out” and often times high impact nature of HIIT, these types of workouts are generally not recommended for those who are just starting an exercise regimen. New types of HIIT programs are beginning to appear, incorporating cycling as a lower impact option to those seeking this alternative. While modifications can be made to reduce impact, it is best to consult with your physician or physical therapist to see if this type of exercise regimen is appropriate for you and your fitness goals.

While HIIT may not be right for you initially, a physical therapist can help prepare you for the increased physical demands of a HIIT program so that you can train intensely with reduced risk of injury. Hartz Physical Therapy also offers a Medically Adapted Gym program where you could initiate HIIT training, in a supervised setting to optimize your success. Happy training!


Gottschall, J. , Bopp, C. and Hastings, B. (2014) The Addition of High Intensity Interval Training Reduces Cardiovascular Disease Risk Factors and Enhances Strength in Active, Healthy Adults. Open Journal of Preventive Medicine, 4, 275-282. doi: 10.4236/ojpm.2014.45034.

Metabolic Adaptations to Short-term High-Intensity Interval … : Exercise and Sport Sciences Reviews. (n.d.). Retrieved from

Tai Chi and Improving Balance in Older Adults

A popular activity for physical fitness that has recently stepped into the spotlight in the therapy community is Tai Chi. Tai Chi originated in China and has been practiced there for generations. In recent years, it has gained traction as a style of exercise that not only has the traditional health benefits such as lowering blood pressure but also can help reduce fall risk, especially in the older population. Improved balance has even been noted when practicing Tai Chi at its most basic level. Another plus to Tai Chi, is that it can be practiced in the comfort of your own home.

The movements in basic Tai Chi are very gentle, and often require us to use muscles we didn’t even think we had. Muscles, incidentally, that are essential to maintaining our balance on a daily basis.   Because of this, Tai Chi has been shown to reduce risk of falls in all populations, specifically in older adults, by utilizing a regimen of wide stance movements, (strengthening those little muscle groups that are key for maintaining balance) and stretching that keeps the body limber and allows for more natural walking. Because of Tai Chi’s emphasis on controlled breathing, the activity has also been shown to improve how we breathe, reducing your chances of becoming short of breath.

You can find Tai Chi programs and exercises just about anywhere, especially with the use of the internet and fitness videos that can be viewed from your living room. If you’re out shopping, DVDs are also an excellent resource as you can usually find videos with classes at your local supermarket. But if you don’t consider yourself very tech savvy or would rather not sift through piles of DVDs, you can always discuss Tai Chi with your local physical therapist! Most, if not all, physical therapists understand the benefits of Tai Chi and will likely be able to point you in the right direction for classes or teach you the exercises themselves in a safe environment! Here are a couple of things to keep in mind if you’re practicing at home:

  • Make sure you have a wide-open space, too much clutter can result in bumping into objects and possibly tripping!
  • A yoga mat makes a good space for these exercises, as it tends to feel comfortable and will result in less impact on your joints.
  • Take your time! These exercises are all about breathing and meditation, go slow and steady for the best results.

Confidence is one of the most important factors for reducing the risk of falls. Research shows that the more confident we are in our balance, the less likely falls are to occur. One of the best ways to improve confidence is to give yourself options to better yourself. So, if you’re thinking of getting back into exercise for your New Year’s resolution or just want to be safer around the house and in your community, consider giving Tai Chi a try and experience the difference!

Keeping Kids Safe: 3 Hidden Dangers from a Musculoskeletal Expert

As a parent, one of our primary concerns is keeping our kids healthy and happy.  We make sure they are eating right, having an active lifestyle and not getting too much screen time.   Surprisingly, there are a few common kid-behaviors that we as parents may often see our kids doing, without even realizing the potential danger.

SWINGING A CHILD BY THEIR ARMS: Picture the following scenarios:

  • Have you ever been playing the yard with your children and you grab onto their hands and swing them around in a circle? It’s a common thing that we do and kids love it.
  • You are shopping in a department store and your child sees something they really want and they take off for it. Your instinct, as a parent, may be to quickly grab their arm in order to catch them.
  • You are on a walk with your kids, but you’ve found that they have run off ahead of you. You are running to catch up when you see a car coming down the road so you quickly grab your child’s arm in order to protect them.

I’m sure we have all done one of these things at some point and to some extent, this may be a necessary risk, but it is a risk all the same.  Pulling a child abruptly by the arm or holding he/she up by his/her arms has the potential to cause radial head subluxation. Believe it or not, depending on the child, it may not take much force for this to happen. Also called Nursemaid’s elbow, this is common in children because their bones are still growing and have loose ligaments surrounding them.  A abruptly yank or pull could cause the annular ligament to slip over the round portion of the bone. According to this is most often seen in children between the ages of 1 and 4.

If your kids love to be swung around, something to consider is grabbing them under their shoulders instead or asking them pull up a little bit to create a slight bend in the elbow as they swing.  This muscle contraction will help protect their ligaments.  It’s a good idea however, not to engage in this behavior too often when your children are little.

THE “W” SIT:  Usually seen in toddlers, the “W” sit is when a child sits with bum resting on the ground between their legs, legs out to either side with both knees bent and their feet tucked under them. We may marvel at the fact that our kids can actually sit this way! Some kids prefer this position more than other and typically utilize it when playing on the floor. Moving in and out of this position for very short periods is not terrible, however, when the child is sitting in the “W” position for long periods, it can raise some concern.


  • Sitting in this position for long periods puts extra strain on the hips joints and ligaments which can lead to an increase risk for hip dislocation as the child grows.
  • If the child is prone to tight muscles, “W” sitting can cause an increase in muscle tightness in the hips, knees, and ankles.
  • The wide sitting stance of this position also makes it easier to keep the body in an upright position. This leads to decreased core engagement / strength of the abdominals.
  • A little-known potential side-effect of this positioning is its effect on hand preference. As noted, children have a lot more trunk control when “W” sitting which makes it easier for children to pick up items with either hand. You normally wouldn’t think anything of this. However, it can have an effect later when the child is learning to write.

In my case joint laxity and loose ligaments runs in the family, so when I saw my 18-month old daughter starting to sit in this position for long periods, I immediately corrected her. I simply would lift her up and put her into a better position that still allowed to play. For example, I would lay her on her stomach to color, or have her sitting with her legs stretched out and a toy between her legs.

TOE WALKING:  Toe walking, when the child walks on their toes or the balls of their feet, is very common in children that are learning to walk.  Typically, it is not something that should cause concern, however, according to Mayo Clinic, it should raise some concern when the child is still toe walking after the age of 2 years. Possible causes for kids to continue toe walking past the age of 2 include:

  1. Tight Achilles Tendon– this is the tendon in the back of the lower leg that attaches to the heel.
  2. Cerebral Palsy– this is a disorder of movement that affects muscles tone
  3. Muscular Dystrophy – this is a genetic disease in which the muscle fibers are prone to damage and weakening over time
  4. Autism– toe walking has been linked to this spectrum disorder

Toe walking does not necessarily mean that your child has one of the conditions listed above, however should this behavior continue past 2 years old, it is a good idea to ask your doctor about it.

Well there you have it, maybe you’ve seen these behaviors in your kids and maybe you haven’t, but either way, you are now a little more prepared to keep young kids safe!

Effects of Bad Posture & How to Fix It

Have you ever noticed that grandma or grandpa seem to lose inches as they age and sometimes may seem to have a rounded upper back?  Well, the truth is, some of this is just the natural aging process, but there are things we can do now to prevent and correct this curving of the spine before it’s too late!

WHAT CAUSES THIS?  Well, nature does play a role, however a sedentary lifestyle and time spent on computers and smart phones can accelerate the decline.   As Americans, we often don’t realize how easily we are sucked into the sedentary lifestyle due to our jobs and advances in technology.  Everything is just becoming too convenient! All these things have a detrimental effect on our posture, which, in turn, can have other consequences on our bodies.

THIS CAN LEAD TO OTHER ISSUES: Yes, that’s right, other than the physical effects posture has on your outward appearance, bad posture also affects you in other ways.

HEADACHES: Looking down at your desk, phone or computer causes a forward bend in your neck. Staying in this position for an extended period or even short periods several times throughout the day can cause headaches. Why?  Well, when you are hunched over and looking down, you are decreasing the curve in your cervical spine putting excess strain on the muscles in the back of your neck as they are working overtime to keep your head from falling. This excess strain on those muscles is one of the many reasons you can get headaches.

DIGESTION: Sitting with bad posture for longer periods can also have an effect on your digestive organs. Just picture your organs all curled up in the normal position and then picture them with them folded over on each other with an extra 20 lbs of pressure on them. Does that give you an uncomfortable visual? This bad posture is putting extra pressure on your digestive organs, not allowing them to function properly.

POOR MOTIVATION: Not many of us think of poor posture being related to motivation, but it is. Studies have shown that being hunched over causes increased emotions of fearfulness, low self-esteem and having higher chances of being in a bad mood.

BACK: Your body has 3 natural curves: cervical, thoracic and lumbar.  When slouching for long periods of time, whether in the car, at work, on the sofa, day after day this can negatively affect your back and put increased pressure/ stress on different areas. The longer the behavior occurs the more negative effects it can have on your body by putting your body in this unnatural position.

The bottom line is, proper posture keeps you in a position that causes the least amount of strain on your muscles and ligaments.

So, what can we do to improve our posture?

Maintaining the proper posture after having bad posture is work and it takes time, however it is worth it! You need to be consciously aware of your body’s position.  The following are suggested positioning for seated and standing posture.

SEATED: When in a seated position you should have your feet planted on the floor or a foot rest if your legs are too short for the chair. Keep feet in front of your body and do not cross your legs.  Your knees should be at a 90-degree angle with the seat of the chair far enough away from the back of your knees to create a gap. Your back should be in an upright position with low and mid back support. Shoulders are relaxed, and elbows bent at a 90-degree angle (forearms parallel to the ground).

STANDING: When standing, most of your weight should fall on the balls of your feet. Knees should be slightly bent and hip width apart. Your back should be upright and tall with your shoulders pinched back. Pulling your tummy in will give your back some extra support. Your head should be held high and level.

* images from

Again, improving your posture is not always easy. It will take a conscience effort!   Put a timer on your phone or a sticky note on your desk as a reminder for yourself. If your car or seat at work is not providing you with the correct amount of low and mid back support, you can roll up a towel and place in the area you are lacking support.  Over time good posture will put less strain on your body.

Here is a great video with some quick tips on proper posture while on the computer

CLICK HERE for some great workday stretches!

If you have any questions about posture or what exercises you can do to help, feel free to contact a therapist at one of our offices to make an appointment. We would love to help you achieve your goals!

3 Pitfalls to Avoid when seeking a Physical Therapist

Your favorite restaurant is closing due to a health code violation. A new teapot is shattered because the mailman dropped your package.  That “contract-free” phone plan has you tied down for two years.  Different industries have different shortcomings and physical therapy care is no different. Below are three key checkpoints to make sure that you are getting the care you deserve at your rehab facility:

  1. CHECK THE PATIENT FLOW: Shall we state the obvious? More patients create more revenue. With that reality it can be very tempting for clinics to attempt to pack in as many patients as possible, thereby increasing the payday. If you find that every time you see your therapist, you are rushed through your treatment, then maybe it’s time to look elsewhere. Sure, a productive clinic can be busy, however a quality clinic should make you feel heard and understood at your sessions. There should be appropriate time to have your complaints addressed and your questions answered without being brushed aside. In addition, ensure you have proper supervision while you perform your exercises. If your treatment team is burdening you with four exercises and consistently leaving (hopefully not for coffee breaks) you might also want to reconsider the quality of care you are receiving.
  2. APPROPRIATE EXPLANATION OF PAIN NECESSITY: Many patients have experienced self-described “torture” at the hand of physical therapists. Although there are some occasions where pain may be necessary, the rationale for pain provocation should be explained thoroughly.  The patient should be in control and have the power to say when “enough is enough”. Trusting your therapist and having them respect your pain tolerance is crucial. Pain in therapy must be productive.
  3. CONSISTENCY IS KEY: Consistent care by qualified professionals has been proven to result in better outcomes. In other words, seeing the same patient care team virtually every visit, including frequent 1-on-1 follow-ups with the Physical Therapist. Patient care being passed from clinician to unfamiliar clinician with no consistent follow up can lead to disorganized care, inconsistent treatment sessions, and a superficial understanding of you and your treatment regimen. Certainly, clinician vacations, illness, or unforeseen circumstances may change your treatment team temporarily but for the most part, having access to a consistent team of providers will facilitate continuity of care.

Three top pitfalls among physical therapy clinics are a “factory approach” to care, inconsistency in your treatment team, and pain without corresponding gain in function. If you think your provider is falling into one of these traps, it may be time to look around. As an independent small business, our values of focused attention, consistent care, and appropriate application of treatment intensity are keys to our success during the past 20 years. We invite you to Experience the Difference for yourself.

5 Easy Tips for Pain-Free Gardening

For most of us, spring and summer is the time of year when the weeds in our yard start calling!  When the weeds go crazy, we might feel overwhelmed and want to do it all in one weekend, however, as I’m sure you have figured out, this is not a great idea.  Overdoing it can often mean an increase in aches and pains, especially back pain.

Whether you are planning on weeding the flower beds, mulching, pruning, planting, or all of the above, there are a few steps you can take to help prevent residual soreness the following few days.

GET THE GEAR:  Before working in the yard, it is important to have to proper gear: hat, suntan lotion, sunglasses, and a water bottle.  You’ve all heard it before, staying hydrated and protected from the sun is a must!

WARM-UP:  Get those muscles warmed and loose by going for a short 5-10 minute walk.  In addition, it is a good idea to perform some dynamic stretches, such a walking lunges with a torso twist, skipping or high knee walking.  Yard work is hard work and skipping a warm-up will put excess strain on your muscles and joints, increasing your chance of an injury.

TAKE BREAKS: Don’t get so caught up in the work, that you forget to take frequent breaks. They don’t have to be long, but it is important to take time to stretch and get a drink of water.

CHECK YOUR FORM: Whether it’s bending over weeding, shoveling or spreading mulch or pushing a lawn mower, all of these jobs put extra strain on your back. By altering your form while you do some of these activities, you can decrease your chances of having back pain.  Here are some suggestions:

– Good idea: Kneel on a soft mat to save your back and knees.
– Better idea: Sit on a stool and rest your elbows on your knees
– Change positions frequently to avoid overuse

Trimming the Hedges:
– Keep your back straight
– Utilize small strokes to prevent strain in neck and shoulders
– Rest every 5-7 minutes to give you back a rest… it will thank you later.

Wheel barrel:
– Bend your knees to lift, NOT your back
– Try not to twist while holding the handles. Wheel barrels can easily be unbalanced…if it starts to go, you do not want to be pulled down with it.
– Push, do not pull.

– Keep feet firmly planted on the ground
– Keep hips forward, facing where you are shoveling to prevent twisting of the back
– If you are moving dirt from one place to another, pick up your feet and turn your entire body to face the side you will be placing the dirt. This may seem unnatural and may take a little longer, however you could be saving your back from days of soreness.

Lifting :
– As temping as it is to get it all in one load, save your back and take two trips with smaller loads.
– Make sure to keep the load close to your body.

COOL DOWN/STRETCHINGOnce you’ve had your fill, it is a good idea to take a few moments to cool down and stretch.  Often your body might tell you what body part could use a good stretch, but if you are looking for a few suggestions, we’ve got you covered:

Yard work can be fun, especially when you get the whole family involved, but taking a few steps to lesson injury risk can go a long way to keeping the garden weed-free all summer long!

Osteoporosis- Tips to Keep those Bones Strong

What is contentious, funny, serious, can be picked, has its own song named after it, and is only appreciated when broken? The answer: a 206 piece puzzle you carry around with you every day. Not only does it keep you from falling into a soft puddle of ooze on the floor, your bones also help form blood cells (red and white), store and release minerals, hold (and hide!) some triglycerides, and protect your brain and spine. When it comes to your bone health, osteoporosis is a chief concern to wrecking your source of stability. Here are key lifestyle changes that will reduce your risk for fractures, as well as a quick peek at the disease process itself.

What is osteoporosis? It all relates back to that mineral holding and releasing property mentioned earlier. If your body keeps stealing your bone minerals for other functions, the skeleton loses its density, causing bones to become more brittle, thereby increasing likelihood of fracture.

So where does this come from and who does it affect? Women are the strong favorites for osteoporosis, as well as the elderly. Other risk factors include: Family history, European or Asian descent, sedentary lifestyles, smoking, low calcium/Vitamin D intake, more than 2 drinks imbibed daily, as well as certain prescription medications which increase your risk.  Granted, some of these risk factors can’t be helped. Changing your family history or age is truly impossible, despite our best efforts!  However WE CAN focus on changing some lifestyle factors affecting the disease.

Medication may feel like the easy way out of bone compromise. There are generally two types of drugs: Antiresorptive drugs which slow down bone loss, and bone-building drugs, which promote increased bone mass. However some of these drugs can increase your risk of cancer, heart disease, and other side effects, warranting a discussion with your doctor before utilizing such medication.

A more natural option is focusing on mineral intake. Calcium and vitamin D are crucial in building bone mass. Calcium alone is difficult for the body to utilize without vitamin D. Once again speaking with a doctor or nutritionist is important in setting dietary goals and intake levels. Other dietary changes can include reducing alcohol consumption and ceasing smoking.

Finally, low impact exercises can be very beneficial in building bone mass. Walking, hiking, dancing, lifting weights, and biking are all excellent option to improve bone mass. However in cases of severe osteoporosis, low impact exercise, such as swimming, may be a better starting point. Talk to us, your local movement experts, for recommendations for a good exercise plan tailor-made to keep you happy and growing stronger! Here at HARTZ PT, we offer a Medically Adapted Gym (MAG) which is designed to customize your fitness goals with a supervising exercise physiologist.  Our Better Bones, Better Balance Class is also designed to keep you on your feet and reduce injury and the fear of falling, allowing you to move with confidence.

No matter where you are in your bone health journey, let us help you stay healthy or improve your health with our exceptional therapy services, tailored gym work-outs, or focused balance classes. Remember, you have a lot of bones to keep in working order!

Direct Access to Care Results in Cost Savings

Researchers in South Carolina have completed a 2-year study (click for link) comparing claims and outcomes data for a group of patients suffering from neck and back pain.  The patients were divided into two groups:

  • Those who selected treatment through physical therapy first (Direct Access).
  • Those who chose traditional routes to care, primarily consultation with a physician first.

They found that improvement in pain and disability was similar, but direct access patients with neck or back pain incurred $1,543 lower average costs than those who chose referral from a physician, with no adverse events.

What does this mean for me?   Patients should consider physical therapy as a first option for pain relief.  Physical therapists are experts at identifying imbalances and weaknesses in the musculoskeletal system, which often lead to pain.  At the same time, we know our limitations and will refer patients to the best physicians in the area, if necessary.

Heel pain? Read this.

Achilles Tendinitis can happen to both runners and non-runners alike.  People suffering from achilles tendinitis typically experience pain and soreness located on the back of the heel where our achilles tendon attaches our calf muscle to our heel bone (calcaneus).  The achilles tendon, sometimes called the heel cord is the largest and strongest tendon in the body.  It comes from the 2 big muscles in our calves (Gastrocnemius and Soleus) and helps us to come up on our toes when we walk or run. 

 Some of the symptoms of achilles tendinitis include stiffness in the back of the heel along with pain and soreness when there is pressure on the heel.  Often times, the back of your shoe can rub the sore spot and aggravate the area.  If the tendinitis lasts for a long time it can result in a thickening of the tendon and chronic achilles tendinitis places individuals at a greater risk for a rupture or tear of the tendon.

There are several possible causes of Achilles tendinitis but the most common is overuse of the tendon.  Runners and athletes are at a higher risk of developing achilles tendinitis as a result of increased forces placed on the tendon.  Sudden increases in activities such as running and jumping can also cause the tendon to become inflamed.  Tightness in the ankle and tendon can make an individual more prone to developing achilles tendinitis.  In addition, people with very flat feet who overpronate (ankles collapse inward) are also more prone to developing achilles tendinitis. 

Treating achilles tendinitis includes resting the tendon by decreasing activity or by immobilizing the ankle through a cast or walking boot.  Icing the heel cord for 10-15minutes throughout the day is a helpful way to reduce the inflammation present in the tendon.  Just make sure to place a towel / cloth between the ice and the skin to avoid skin irritation.  Other treatments include wearing a Dorsal Night Splint (DNS) to help promote a gentle stretch of the achilles while you are sleeping.  Sometimes, NSAIDS are needed to help reduce pain and inflammation in the achilles.  As the symptoms decrease, it is important to begin a stretching and strengthening program to help improve the integrity of the tendon and prevent the chances of having the issue reoccur.  In severe cases, surgery may be required to help repair the tendon.

If you are having difficulty treating the pain and soreness on your own, physical therapy can be effective in guiding you with appropriate stretches and strengthening exercises for the achilles.  In addition, PT can assist you in returning to the things you love including running and walking.

Finally, the best way to treat achilles tendinitis is to avoid it all together.  A proper warm-up of 5-10 minutes of very light activity to get your blood flowing is important.  Follow that with some gentle calf stretches and heel raises to ensure that the achilles tendon is ready for action.  And finally, remember to wear good supportive athletic shoes whenever you are going to be active.